Healthcare Provider Details

I. General information

NPI: 1548350531
Provider Name (Legal Business Name): LOBNA ELHASAN-FAKIH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 MONROE ST
DEARBORN MI
48124-3013
US

IV. Provider business mailing address

2547 MONROE ST
DEARBORN MI
48124-3013
US

V. Phone/Fax

Practice location:
  • Phone: 313-528-3700
  • Fax: 313-791-8302
Mailing address:
  • Phone: 313-528-3700
  • Fax: 313-582-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301064108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: